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§ 1219.3. Discounted reimbursement and disclosure of reimbursement terms prohibited

Oklahoma Statutes AnnotatedTitle 36. Insurance

Oklahoma Statutes Annotated
Title 36. Insurance (Refs & Annos)
Chapter 1. Insurance Code (Refs & Annos)
Article 12. Unfair Practices and Frauds (Refs & Annos)
Health Care Fraud Prevention Act
36 Okl.St.Ann. § 1219.3
§ 1219.3. Discounted reimbursement and disclosure of reimbursement terms prohibited
Currentness
A. An insurer or third-party administrator shall not reimburse a health care provider on a discounted fee basis for covered services that are provided to an insured unless:
1. The insurer or third-party administrator has contracted with either:
a. the health care provider, or
b. a preferred provider organization which has contracted with the health care provider;
2. The health care provider has agreed to provide health care services under the terms of the contract; and
3. The insurer or third-party administrator has agreed to provide coverage for those health care services under an accident and health insurance policy.
B. A party to a preferred provider contract, including a contract with a preferred provider organization, may not sell, lease, or otherwise transfer information regarding the payment or reimbursement terms of the contract without the express authority and prior adequate notification of the other contracting parties.

Credits

Laws 2000, c. 353, § 6, eff. Nov. 1, 2000.
36 Okl. St. Ann. § 1219.3, OK ST T. 36 § 1219.3
Current with emergency effective legislation through Chapter 295 of the Second Regular Session of the 59th Legislature (2024). Some sections may be more current, see credits for details.
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